Cost-Effectiveness of Thrombolytic Therapy, Compared with Anticoagulants Therapy in the Treatment of Acute Myocardial Infarction in Albania
DOI:
https://doi.org/10.3889/oamjms.2015.060Keywords:
Acute Myocardial Infarction, Cost-effectiveness, Thrombolytics, Streptokinase (SK), Reteplase(r-Pa), anticoagulantsAbstract
AIM: The study aim is to evaluate the cost-effectiveness of thrombolytic treatment in acute MI comparing with anticoagulants therapy and between each other thrombolytic (SK, r-Pa).
MATERIAL AND METHODS: We used a prospective registry of all patients admitted for acute myocardial infarction in intensive care units in Tirana. The average drugs cost was calculated for the hospitalization period in Albanian money (ALL). Survival and life quality were estimated by phone contact 1 year after acute MI.
RESULTS: Anticoagulant group cost is 23865.3 ALL (170.5€), SK group cost is 54148.63 ALL (386.7€), r-Pa group has a cost of 92184.90 ALL (658.5€). In the group treated with SK the hospital survival is 100%, while in the control group 88.8%. Reteplase group has a lower period of stay in hospital than SK group 13.04 days vs. 17.97 days, mean age in group treated with r-Pa is 64.29 ± 10.03 approximate with anticoagulant group mean age 64.17 ± 11.08; differ significantly with SK group mean age 56.75 ± 10.04. Survival after 1 year was 96.4% for r-Pa and 96.9% SK.
CONCLUSIONS: SK and r-Pa are successful thrombolytics with high effectiveness. It is gained a higher survival with the thrombolytic treatments. Reteplase is well tolerated in older patients than SK, is easier to apply than Streptokinase, but has higher cost.Downloads
Metrics
Plum Analytics Artifact Widget Block
References
Myocardial infarction and coronary deaths in the World Health Organization MONICA Project. Registration procedures, event rates and case-fatality rates in 38 populations from 21 countries in four continents. Circulation. 1994;90(1):583-612. DOI: https://doi.org/10.1161/01.CIR.90.1.583
Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients [published erratum appears in Lancet. 1994; 343:742]. Lancet. 1994; 343:311-22. DOI: https://doi.org/10.1016/S0140-6736(94)91161-4
Fibrinolysis for acute myocardial infarction: current status and new horizons for pharmacological reperfusion, part 1. Circulation. 2001; 103 (23):2862-6. DOI: https://doi.org/10.1161/01.CIR.103.23.2862
White H, Van de Werf F. Thrombolysis for acute myocardial infarction. Circulation. 1998; 97:1632–1646. DOI: https://doi.org/10.1161/01.CIR.97.16.1632
Maizel AS, Bookstein JJ. Streptokinase, urokinase, and tissue plasminogen activator: pharmacokinetics, relative advantages, and methods for maximizing rates and consistency of lysis. Cardiovasc Intervent Radiol. 1986; 9(5-6):236-44. DOI: https://doi.org/10.1007/BF02577952
Reteplase: a new thrombolytic for the treatment of acute myocardial infarction. Ann Pharmacother. 1999; 33(3):318-24. DOI: https://doi.org/10.1345/aph.18006
The GUSTO Investigators. An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med. 1993; 329:673-82. DOI: https://doi.org/10.1056/NEJM199309023291001
Randomised, double-blind comparison of reteplase double-bolus administration with streptokinase in acute myocardial infarction (INJECT): trial to investigate equivalence. International Joint Efficacy Comparison of Thrombolytics. Lancet. 1995;346(8971):329-36. Erratum in: Lancet 1995;346(8980):980.
Llevadot J, Giugliano R, Antman E. Bolus fibrinolytic therapy in acute myocardial infarction. JAMA. 2001; 286:442–9. DOI: https://doi.org/10.1001/jama.286.4.442
Hanratty B, Lawlor DA, Robinson MB, Sapsford RJ, Greenwood D, Hall A. Sex differences in risk factors, treatment and mortality after acute myocardial infarction: an observational study. J Epidemiol Community Health. 2000;54(12):912-6. DOI: https://doi.org/10.1136/jech.54.12.912
More rapid, complete, and stable coronary thrombolysis with bolus administration of reteplase compared with alteplase infusion in acute myocardial infarction: RAPID Investigators. Circulation. 1995; 91: 2725–2732. DOI: https://doi.org/10.1161/01.CIR.91.11.2725
Dundar Y, Hill R, Dickson R, Walley T. Comparative efficacy of thrombolytics in acute myocardial infarction: a systematic review. Q J Med. 2003; 96:103–13. DOI: https://doi.org/10.1093/qjmed/hcg016
International Joint Efficacy Comparison of Thrombolytics Randomized, double-blind comparison of reteplase double-bolus administration with streptokinase in acute myocardial infarction (INJECT): trial to investigate equivalence. Lancet. 1995; 346: 329-336. DOI: https://doi.org/10.1016/S0140-6736(95)92224-5
Bode C, Smalling RW, Berg G, et al. Randomized comparison of coronary thrombolysis achieved with double-bolus reteplase (recombinant plasminogen activator) and front-loaded, accelerated alteplase (recombinant tissue plasminogen activator) in patients with acute myocardial infarction: the RAPID II Investigators. Circulation. 1996; 94: 891–898. DOI: https://doi.org/10.1161/01.CIR.94.5.891
Krumholz HM, Pasternak RC, Weinstein MC, Friesinger GC, Ridker PM, et al. Cost Effectiveness of Thrombolytic Therapy with Streptokinase in Elderly Patients with Suspected Acute Myocardial Infarction. New Eng J Med. 1992; 327:7-13. DOI: https://doi.org/10.1056/NEJM199207023270102
Survival Outcomes 1 Year After Reperfusion Therapy With Either Alteplase or Reteplase for Acute Myocardial Infarction Results From the Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) III Trial. Circulation. 2000;102:1761-1765. DOI: https://doi.org/10.1161/01.CIR.102.15.1761
Downloads
Published
How to Cite
Issue
Section
License
http://creativecommons.org/licenses/by-nc/4.0
